It is time to introduce pneumococcal conjugate vaccine in India: Dr. Katherine L. O'Brien

India has one of the highest burdens of pneumonia around the world and the most common bacterial cause of pneumonia is a germ called pneumococcus. The good news is that there is a vaccine against pneumococcus and it works really well.Shahid Akhter | ETHealthWorld | March 31, 2017, 15:09 IST

India recently approved the National Health Policy that speaks about universal health coverage. What role do you think vaccination plays in the concept of ‘health for all’?

Vaccines are a critical part of assuring health and survival of all children around the world and for India assuring vaccines are part of the universal healthcare package is a really critical intervention.

Pneumonia is the leading cause of death among children under the age of five. Considering it is a major public health issue, not only in India, but also around the world, what is being done globally to counter this?

Around the world, there are enormous efforts going on right now to initiate and accelerate interventions to do something about pneumonia deaths among young children. These include packages of vaccine interventions, series of vaccines that can address the most common causes of pneumonia death, but also efforts to promote prevention of pneumonia and protection of children against pneumonia. Those include things like clean drinking water, sanitation, increasing breast feeding rates and protection of children through good nutrition and assuring that they are able to fight the germs that cause pneumonia.

The Government of India has announced the introduction of the pneumococcal conjugate vaccine (PCV) under its national immunization programme. What impact will this initiative have considering that India has one of the highest burdens of pneumonia in the world?

India does have one of the highest burdens of pneumonia around the world and the most common bacterial cause of pneumonia is a germ called pneumococcus. The good news is that there is a vaccine against pneumococcus and it works really well. So, India is about to start the introduction of that vaccine as a part of the routine immunization schedule for all the newborn children. What we have seen in other countries is that, when a programme like this rolls out and is used among all kids, there is a really substantial reduction of the number of children not only who die but also children who survive and suffer the consequences of the illness.

Can you tell us more about PCV and how safe and effective is it?

PCV is a vaccine that is used in over 130 countries around the world and as a result it is one of the most studied vaccines that we have ever had. It is an incredibly safe vaccine that is highly effective against the strains of pneumococcus—the germ it’s directed towards—that is in the vaccine. We have got a huge experience in use of this vaccine for over 15 years now, starting first in the year 2000 and rolling out now to dozens, tens, hundreds of countries around the world.

Since the Hib vaccine, part of the pentavalent vaccine, is already part of the Universal Immunization Programme in India, why does India need a second vaccine against pneumonia?

There is another bacterium called Hib that is a well-known cause of meningitis and of pneumonia. We have a vaccine against Hib which is used routinely here in India. The reason why we need another vaccine—the PCV vaccine—is that there are many different causes of pneumonia, but Hib and pneumococcus are the two most common bacteria that cause pneumonia and are the two most common causes of fatal pneumonia. So, having already introduced Hib, it’s really time to introduce PCV and deal with this second killer of children.

Antibiotic resistance is an emerging public health issue all over the world and India. Can vaccines like PCV help combat this issue?

Anti-microbial resistance is seen with a number of different bacteria. Pneumococcus is one of the bacteria that has anti-microbial resistance and the interesting thing is that the strains that are in the pneumococcal vaccine are the strains of pneumococcus that are most likely to be resistant to antibiotics. So, giving vaccine is an incredibly powerful tool to reduce not only pneumococcus but very specifically the resistance that is seen in pneumococcus.

Many people argue that diseases like diarrhoea and pneumonia can be avoided if children have access to good nutrition, clean water, sanitation and hygiene alone. What are the benefits of vaccination compared to these other health interventions?

Choosing preventive techniques is not an either-or. We should be promoting and investing in all of the preventive techniques for a community of children, just like we would for our own children. So, adequate nutrition, clean sanitation—all of these are important things to invest in and assure that they are available to all children, but so are vaccines. These are complimentary interventions and it is not choosing one or choosing the other.

What is the relation between pneumonia and pollution; given the high pollution levels we see in India, how will this impact the rates of pneumonia amongst Indian children?

Poor air quality is one of the very significant risk factors for children to get pneumonia from either viruses or from bacteria. One of the questions that comes up a lot is, why does one child get pneumonia and not another child, and part of this has to do with their exposure to pollution.

This vaccine is particularly important among children who are living in settings where they have a lot of exposure to poor air quality because they are at particular risk of getting the disease.

139 countries in total have introduced PCV in their national immunization programme, what are some of the lessons India can learn from other developed and developing countries who have introduced the vaccine in the past?

The path to introduction and the impact of vaccine is a well-trodden path. What we have seen in both- developed countries and in developing countries is that this is the vaccine when used in children saves lives, and not only does it saves lives but it saves money. Saves money for families and for governments. So, this is not only a vaccine that has health benefits but it also has economic benefits for parents and for communities.

What are the economic benefits of this vaccine for the government as well as the families?

When we think about the economic benefits, for families this is really about prevention of dollars spent, rupees spent on caring for children who get sick. This is avoiding the costs of going to the doctor for a respiratory illness, avoiding what can be extraordinary catastrophic economic cost for families whose children are severely sick in the hospital especially from pneumonia or meningitis. For governments, the other way that we think about economic costs is the return on the investment of vaccines, and we have seen that vaccines are probably one of the most beneficial economic interventions possible for governments. It creates health but it also creates wealth within the population.

It is not only children who are at risk of contracting pneumonia, but the elderly too. Are there ways our society will be able to lower or eliminate the risk of pneumonia amongst older demographics who have not received PCV?

One of the remarkable things about the PCV vaccine is that it protects not only those children who are themselves vaccinated but, because pneumococcus is a germ that is carried in your nose and passed from one person to the next, and because children are the most likely people within the community or the household to transmit the germ, when we immunize children, we actually protect not only them but also the older people that they are around from pneumococcal disease. So, though we are not vaccinating older people, what we have seen from other countries is that there is a tremendous benefit to older individuals who themselves are not vaccinated, just because the kids that they are around have been vaccinated and protected.

How does the vaccination program in the US differ from that in India ?

In the US, PCV is part of the routine immunization schedule. It’s exactly the same vaccine that’s going to be introduced into India. There are some differences between the program in the US and the program in India in terms of the timing at which the doses are given. These are small differences in choice of program to tailor it to the country setting. But this is a routine, normal part of both immunization schedules.

It’s been a vaccine which has shown extremely high safety in the US and extraordinary benefits, beyond what was expected from the vaccine for people who were not actually immunized, the age groups that don’t actually get the vaccine, older people and parents of children who are vaccinated. I think what we are expecting out of the Indian program is extraordinary benefit and probably of the same magnitude if not greater than what was seen in the US.

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